EPILEPSY315PG.JPG
just before bedtime, Paola at left jumps with her sister Niki on Niki's bed.
eight-year-old Paola First diagnosed with epileptic seizures four years ago, at school and home and at hospital. Under the supervision of Donald Olson, MD, director of pediatric epilepsy at LPCH, Paola has been able to reduce her seizures via medication from around 50 a day to 10 or so when times are good. Silvia Humildad is the mom.t Monterey Park School then at home.
The San Francisco Chronicle, Penni Gladstone
Photo taken on 1/12/05, in Salinas,

Photo: Penni Gladstone

EPILEPSY315PG.JPG
just before bedtime, Paola at left jumps with...

Image 2 of 4

EPILEPSY068PG.JPG
eight-year-old Paola during lunch. First diagnosed with epileptic seizures four years ago, at school and home and at hospital. Under the supervision of Donald Olson, MD, director of pediatric epilepsy at LPCH, Paola has been able to reduce her seizures via medication from around 50 a day to 10 or so when times are good. Silvia Humildad is the mom.t Monterey Park School then at home.
The San Francisco Chronicle, Penni Gladstone
Photo taken on 1/12/05, in Salinas,

Photo: Penni Gladstone

EPILEPSY068PG.JPG
eight-year-old Paola during lunch. First...

Image 3 of 4

EPILEPSY482PG.JPG
her beautiful black hair being shaved.
eight-year-old Paola First diagnosed with epileptic seizures four years ago, Here at hospital. Under the supervision of Donald Olson, MD, director of pediatric epilepsy at LPCH, Silvia Humildad is the mom.The San Francisco Chronicle, Penni Gladstone
Photo taken on 1/12/05, in Palo Alto,

Photo: Penni Gladstone

EPILEPSY482PG.JPG
her beautiful black hair being shaved....

Image 4 of 4

EPILEPSY366PG.JPG
Sylvia cries after she watched Paola go to sleep after being given anesthesia.
eight-year-old Paola First diagnosed with epileptic seizures four years ago, Here at hospital. Under the supervision of Donald Olson, MD, director of pediatric epilepsy at LPCH, Silvia Humildad is the mom.The San Francisco Chronicle, Penni Gladstone
Photo taken on 1/13/05, in Palo Alto,

Photo: Penni Gladstone

EPILEPSY366PG.JPG
Sylvia cries after she watched Paola go to sleep...

STANFORD / An operation to make things right / Procedure to remove brain tissue may help 8-year-old girl who suffers from epilepsy

Paola Mendez is 8 years old, and she knows something is wrong inside her brain.

Without warning, it betrays her. She loses control of her senses for a few seconds or has epileptic seizures so intense that all she can do for hours afterward is sit limply in her mother's lap. At school, her teacher keeps a bed ready so she can rest after what the other children call her "cesars." There are days when she has 20 of them.

In the past four years, Paola has tried a changing array of anti-seizure drugs. She's been in and out of hospitals while doctors tested her, stuck electrodes on her scalp and examined pictures of her brain. Now they are turning to one last hope to control the seizures that doctors say, if left unchecked, could cause irreversible brain damage.

Today, using three-dimensional pictures made possible by new imaging technology, doctors at Stanford plan to remove the brain tissue causing her seizures. Doctors at Lucile Packard Children's Hospital have been doing the procedure for about 10 years, but recent advances in their ability to see the brain and guide instruments into it have made the surgery far more predictable -- and thus a better option for people like Paola who have the severest form of epilepsy.

Not that it was an easy call for her parents to make. Paola's mother, Silvia Humildad, a housecleaner, and father, Manuel Mendez, who both have family histories of epilepsy, agonized over what at first seemed unthinkable - - having doctors cut out a piece of their daughter's brain. Mendez had watched his younger brother die after a seizure, but still had doubts.

"This is something so different," Humildad said as her husband sat alone staring out the kitchen window. "He just is not sure."

About 2.5 million Americans have epilepsy, an abnormality in the brain's electrical rhythms that is the most common neurological disorder. Only a small portion of those have what is called "intractable epilepsy," which can't be controlled by drugs. For them, surgery to remove pieces of the brain is the only chance for a cure.

Last week, doctors implanted an electrode grid on the surface of Paola's brain so they could monitor the area they suspected was causing her seizures. What had looked like a dimple in brain scans was actually a small depression on one side of her frontal lobe. Doctors found the exact spot by using instruments equipped with a global positioning system. Their route through the brain was illuminated on a monitor, the way drivers look for directions on screens in their cars.

"Here it is, right here," said Dr. Michael Edwards, peering at an exposed portion of the brain, where the indentation looked like a small pool of ink. Tests over the next week determined he could cut it out without affecting her ability to speak or move.

"I think Paola understands," Humildad said. "She said, 'I know they are going into my brain to take out the seizures.' "

The problem that surgeons could see clearly in the operating room didn't cause problems until Paola was 4. Until then she had been an active, outgoing child. The first seizure happened one day when Humildad was taking her daughter to preschool.

Humildad, not realizing it was an epileptic seizure, took Paola to an emergency room in Salinas. A brain scan appeared normal.

A few days later Paola had another seizure, this one worse. She collapsed and her arms and legs jerked violently. Eventually, Humildad took Paola to UC San Francisco, where doctors diagnosed her with epilepsy.

The seizures grew so frequent that Paola began sleeping with her parents so they would be nearby if she had one at night. Her three sisters helped take care of her. "At one point, her seizures were so bad she was like a little baby again," Humildad said. "We were locked in the house with her."

Whenever she had a series of seizures, Paola couldn't talk or walk on her own. Her parents wheeled their 8-year-old around in a stroller. At school, she was placed in a special education class, where she struggled to relearn what she'd lost.

When she was well for a few days she became again the girl with a mischievous smile who loved dancing, Mexican music, the color pink and any movie about princesses.

Her classmates, who have a variety of developmental and health disabilities, learned what to do when she had seizures. They would gather around her and pat her back or cover her with a blanket, then finish their lessons while she slept. One little boy always finished her art projects for her and left them on her desk.

"There is just something about Paola that draws people to her," her mother said.

While her parents worried Paola would never have a normal life, they struggled with their own problems. Medi-Cal paid for Paola's treatment, but they couldn't afford to miss work when she was sick. Even church fell by the wayside, Humildad said. She had no time, and the weight of Paola's illness made her doubt her faith.

The couple had no help from their families. Humildad, who had left her home in Yuma, Ariz., shortly after ninth grade, was estranged from her mother and had never met her father.

Mendez, who grew up in a rural town in Mexico, worked in the lettuce fields during the growing season. He tried to save enough to send some money to his parents.

Paola's illness prompted Humildad to get back in touch with her mother and sisters. Last year, she found her father and learned that he, too, had epilepsy.

At Christmas, she took the whole family to Arizona to meet him and see her mother. She wanted them to know about Paola's surgery.

"I am just hoping to see the girl she was before the seizures," Humildad said. "I just wish all this would go away."

Dr. Donald Olson, Paola's pediatric neurologist, said it would take a few days or weeks to see an improvement from the surgery. About two-thirds of epilepsy surgeries result in elimination of seizures and a quarter in improvement, but 10 to 15 percent of patients see no change.

Last week, doctors passed electricity through the electrodes they'd implanted to make sure the malformed area in Paola's brain did not control any important functions. She sat up in bed, her head shaved and covered with a soft cap, while doctors watched her brain waves on a monitor. Her mother waited for the operation she both hoped for and dreaded.

"I kept asking, 'When are you going to make a medicine with just the right ingredients?' " she said. "I'm just hoping this is the potion."